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Warning, Danger….

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Ethel D. Callier-Perry, M.A., Ph.D. Candidate

Consultant: Harris County Mental Health Jail diversion Pilot Program.

Kingwood, Texas / Management Consulting

Professional Speaker: ‘Aux Populi’ President/Owner – Ethel D. Callier-Perry

Kingwood, Texas / Professional speaker

Current: Harris County, Walden University

Previous: MHMRA of Harris County, Tri-County MHMR

Education: Walden University – Completing Dissertation – PhD / Health Psychology

Contact: ethel.perry@waldenu.edu (832) 527-1090

Presenter

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John Doe is a 58 y/o AA male who have sustained three major strokes that

have left him paralyzed on his right side & difficulty speaking. He can

comprehend. The hospital started physical therapy, rehab therapy, speech

therapy, & occupational therapy. He discharges to an inpatient rehab facility

to continue his treatment. Once he reached maximum benefit, he was

discharged to a nursing home. Family consisted of siblings who had no

medical knowledge. While at the nursing home, all therapeutic services was

Supposed to continue. One family member noticed that her brother’s condition

had regressed & he was not responsive as before. Questioning the medical

staff never happened until she discussed the case with her husband’s sister-in-

law. The sister-in-law who did not have the knowledge in the area of

medicine and nursing homes, a red flag immediately came up. The sister-in-law

informed the sister of the patient to go to the nursing home & see whether

or not he was getting the medical care that had been Rx’s by the MD & to

review his medications.

Case StudyBeers, M. H., Ouslander, J. G., Rollingher, I., Reuben, D. B., Brooks, J., & Beck, J. C. (1991).

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The sister of the brother went one step further & took a good

friend who was an MD with her to the nursing home.

Immediately the MD noted that the brother was being

purposely overmedicated & he was wearing a medication

patch that had expired two months prior for type 2 diabetes,

and there was no diagnostic history. Note reviewing the drug

list that he was taking opioids was inappropriate for his diagnosis, as

well as sleeping agents was inappropriate. Discontinuation of therapy

was an immediate red flag. The family immediately removed their

brother from the nursing home & transferred him to a nursing home

that is properly taking care of their brother

Case Study Cont..

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John Doe has made so much progress that he is walking with the

assistance of a walker & he can make short conversations. Today

he is going on weekend passes with family members to spend the

weekend with each of his siblings & attend church services. In the

next couple of months, John Doe will be able to step down to an

Assisted Living Facility & hopefully back to home living with

family members. The frequency of these type of cases are alarming, yet

this is a case where the nursing home used chemical restraints to

manage their patients. Present legal action is in place for this nursing

home. Note that deaths have occurred in the same nursing homes. And

due to this family legal measures against the nursing home, the cases of

those who died in the nursing homes are being re-opened for possibly

death by unauthorized chemical restraints / overdose.

Case Study Cont….

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Is this a case of substance abuse? The answer is

no, but every day you have nursing homes that

help turn our geriatrics into involuntary

substance abusers.

The nursing home is the drug dealer forcing the

drugs on our loved ones.

Case Study Cont…

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Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home ResidentsMark H. Beers, MD; Joseph G. Ouslander, MD; Irving Rollingher, MD; David B. Reuben, MD; Jacqueline Brooks; John C. Beck, MDArch Intern Med. 1991;151(9):1825-1832. doi:10.1001/archinte.1991.00400090107019.

ABSTRACTIncreasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily available and are not uniform. We used a two-round survey, based on Delphi methods, with 13 nationally recognized experts to reach consensus on explicit criteria defining the inappropriate use of medications in a nursing home population. The criteria were designed to use pharmacy data with minimal additional clinical data so that they could be applied to chart review or computerized data sets. The 30 factors agreed on by this method identify inappropriate use of such commonly used categories of medications as sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, analgesics, dementia treatments, platelet inhibitors, histamine2 blockers, antibiotics, decongestants, iron supplements, muscle relaxants, gastrointestinal antispasmodics, and antiemetics. These criteria may be useful for quality assurance review, health services research, and clinical practice guidelines. The method used to establish these criteria can be used to update and expand the guidelines in the future.(Arch Intern Med.1991;151:1825-1832)

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Han, B., Gfroerer, J. C., Colliver, J. D., & Penne, M. A. (2009).

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 Simoni-Wastila, L., & Yang, H. K. (2006)

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Did you know…… Blow et al., (2002) Older people have a lower

tolerance to specific substances. In comparison to

younger adults the geriatric has an increase

vulnerability to alcohol and an amplified response

to over the counter (OTC) drugs. The Liver enzymes

that help break down the drugs are less efficient

with age, & central nervous system (CNS) sensitivity

increases with age.

If there is a past history of substance abuse, the

elderly is less aware of how their body is not able

to withstand the abuse of prescription drugs,

alcohol, & OTC drugs. Due to age there is a

reduction in lean body Mass Vs. total volume of Fat

= to decrease in total body volume = to an

incline to the total distribution of alcohol & other

chemicals in the body. Any small amounts of substances

such as alcohol or OTC can be problematic for the

elderly (Blow Et. Al., 2002).

Anxiety Tolerance to alcohol or meds Blackouts, dizziness Legal Difficulties Depression Mood Swings Memory loss Disorientation New difficulties in making decisions Poor Hygiene Falls, bruises, burns Family problems Idiopathic Seizures Financial problems Sleep problems Social isolation Incontinence Poor nutrition

Severity of Prescription or Substance Abuse

Signs & Symptoms of Potential Substance Misuse & Abuse in Older Adults

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Bartels, S. J., Blow, F. C., Brockmann, L. M., & Van Citters, A. D. (2005).

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Compton, W. M., & Volkow, N. D. (2006).

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Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003).

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2nd ObjectiveHow to Give Appropriate Intervention to The Severity of Prescription or Substance Abuse

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Intervention – Learn the High Utilizing Populations

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Juurlink, D. N., Mamdani, M., Kopp, A., Laupacis, A., & Redelmeier, D. A. (2003)

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Interventions

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Outreach services Psychosocial Treatment Education & awareness by seniors & caregivers Cognitive Behavioral Treatment Brief Interventions Peer led self help groups such as Alcohol Anonymous

& Narcotics Anonymous Pharmacological interventions

Interventions Sorocco, K. H., & Ferrell, S. W. (2006)

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Intervention

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Prevention - Steps to Take on Your Own

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PreventionSorocco, K. H., & Ferrell, S. W. (2006)

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PreventionSorocco, K. H., & Ferrell, S. W. (2006)

Read the prescription label carefully. When in doubt call your pharmacist or doctor.

Look for pictures or statements on your prescriptions & pill bottles that tell you not to drink alcohol while taking the particular medicine.

If you are taking medications for sleeping, pain, anxiety, or depression, it is unsafe to drink alcohol.

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Prevention While at social events – drink

responsibly!!!

If you have never been diagnosed with a drinking problem, one alcoholic drink a day is the recommended limit for anyone over the age of 65.

That's 12 ounces of beer, 1.5 ounces of distilled spirits or 5 ounces of wine.

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PreventionSorocco, K. H., & Ferrell, S. W. (2006)

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3rd Objective – Building Public Awareness

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Public AwarenessSimoni-Wastila, L., & Yang, H. K. (2006)

Information will ensure appropriate provision of behavioral services

Information to build public awareness of medical health services available to the aging substance abuser

Information to help build public awareness

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Public Awareness - Did You Know….

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Simoni-Wastila, L., & Yang, H. K. (2006)

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Share the Right Information with Your Health Care Professional

Make a list for your doctor of all your medications (including doses), especially on our first visit. Keep it updated and carry it with you.

Simoni-Wastila, L., & Yang, H. K. (2006)

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Share the Right Information with Your Health Care Professional

Remind your doctor or pharmacist about any previous conditions that might affect your ability to take certain medicines such as a stroke, hypertension, serious heart disease, liver problems or lung disease.

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Share the Right Information with Your Health Care Professional

Don’t be afraid to ask questions if you don’t know the meaning of a word, if instructions are unclear, or if you want more information.

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Share the Right Information with Your Health Care Professional

Whenever possible, have your doctor or a member of the medical staff give you written advice or instructions.

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                                     Articles about Addiction

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David Cohen offers expert insights in the Chicago Sun Times "Heroin deaths skyrocket, but hope remains", March 12, 2015. View It >>

WGN-TV interviews David Cohen, director of clinical services at Hazelden in Chicago, March 9, 2015. View It >>

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 Take a virtual tour of our residenceLocated on Chicago's Gold Coast at 867 N. Dearborn St., Hazelden provides a sanctuary of serenity and support for residents beginning their journey of recovery from alcohol and other drug dependence. View It >>

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12 Steps Speak of A Higher Power The Best Intervention of All

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The Big Book

The Big Book

First published in 1939 and subtitled The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, the Alcoholics Anonymous (A.A.) 'Big Book', as it is commonly called, is the first text written about the experiences of the founders of the A.A. movement. It tells the story of Bill W., one of the co-founders of A.A. and how the program worked in the early days of the movement. It is full of much timeless and practical wisdom and is the first standard (and some would say the only standard) text of A.A. and, subsequently, of 12 step programs.You can read the book online (2nd edition) or you can download the book (496 KB download size) in PDF format.A more recent version of the Big Book can also be found online at the A.A. website. The newer versions differ mostly in the stories that are collected at the end of the book about people who have recovered using the 12 step approach

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The Big Book              Overview

             Introduction

             Chapter 1 - BILL'S STORY

             Chapter 2 - THERE IS A SOLUTION

             Chapter 3 - MORE ABOUT ALCOHOLISM

             Chapter 4 - WE AGNOSTICS

             Chapter 5 - HOW IT WORKS

             Chapter 6 - INTO ACTION

             Chapter 7 - WORKING WITH OTHERS

             Chapter 8 - TO WIVES

             Chapter 9 - THE FAMILY AFTERWARD

             Chapter 10 - TO EMPLOYERS

             Chapter 11 - A VISION FOR YOU

             Appendix

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There is Hope..

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ReferencesBeers, M. H., Ouslander, J. G., Rollingher, I., Reuben, D. B., Brooks, J., & Beck, J. C. (1991). Explicit criteria for determining inappropriate medication use in nursing home residents. Archives of internal medicine, 151(9), 1825-1832.

Blow, F. C., Oslin, D. W., Barry, K. L. (2002). Misuse and abuse of alcohol, illicit drugs and psychoactive medications among older people. Generations , 26 (1), 50 - 55.

Compton, W. M., & Volkow, N. D. (2006). Abuse of prescription drugs and the risk of addiction.  Drug and alcohol dependence, 83, S4-S7. Bartels, S. J., Blow, F. C., Brockmann, L. M., & Van Citters, A. D. (2005). Substance abuse and mental health among older Americans: The state of the knowledge and future directions. WESTAT, Rockville, MD. Retrieved, from the World Wide Web: http://www. samhsa. gov/aging/SA_MH_% 20AmongOlderAdultsfinal102105. pdf. pharmacotherapy, 4(4), 380-394.

Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.Archives of internal medicine, 163(22), 2716-2724.

Han, B., Gfroerer, J. C., Colliver, J. D., & Penne, M. A. (2009). Substance use disorder among older adults in the United States in 2020. Addiction, 104(1), 88-96.

Juurlink, D. N., Mamdani, M., Kopp, A., Laupacis, A., & Redelmeier, D. A. (2003). Drug-drug interactions among elderly patients hospitalized for drug toxicity. Jama, 289(13), 1652-1658.

Simoni-Wastila, L., & Yang, H. K. (2006). Psychoactive drug abuse in older adults. The American journal of geriatric pharmacotherapy, 4(4), 380-394.

Sorocco, K. H., & Ferrell, S. W. (2006). Alcohol use among older adults. The Journal of general psychology, 133(4), 453-467.

http://www.12step.org/references/the-big-book/

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Thank you for being a part of our workshop!You have been an AWESOME audience!

Questions????